Modular pedicle screw system

ABSTRACT

A modular anchoring device including a threaded shank for anchoring within a vertebra, an intermediate element and a head portion configured to receive and secure a rigid or non-rigid stabilization rod. The threaded shank, the intermediate element and the head portion of the anchoring device are cannulated to permit percutaneous implantation of the device. The intermediate portion is designed to be removable from the threaded shank portion subsequent to implantation of the anchoring device to enable substitution of another intermediate element having different dynamic characteristics.

FIELD OF THE INVENTION

The present invention relates to dynamic spinal stabilization systems.The invention provides a modular pedicle screw attached to the vertebraeto anchor the stabilization system.

BACKGROUND OF THE INVENTION

The spine is comprised of an intricate system of bones and assortedtissues that supports the body and provides protection of the centralnervous system including the spinal cord and associated nerves. Withinthe spinal column are stacked a plurality of vertebrae separated fromone another by an intervertebral disc that dampens and cushions thecompressive forces exerted upon the spinal column. Located behind theseries of alternating vertebrae and discs is the vertebral canal whichcontains the spinal cord and other associated nerves.

There are more than twenty vertebrae within the spinal column and theyare categorized into one of four classifications: cervical, thoracic,lumbar or sacral. The upper seven vertebrae, including the first sevenextending downward from the base of the skull are referred to as thecervical vertebrae. The next twelve extending downward from the cervicalvertebrae and known as the thoracic vertebrae. Extending downwardly fromthe thoracic vertebrae are the five lumbar vertebrae. At the base of thespinal column is the sacral bone which also includes the coccyx. Thestructural and functional relationship of the vertebrae, discs, muscles,ligaments and nerves enables a healthy normal spinal column to move andarticulate freely almost without limitation.

The spinal column is comprised of the vertebral body, the pedicle, thespinous process, the transverse process, the facet, the laminar arch,and the vertebral canal. The vertebral body is the generallycylindrically shaped weight bearing structure of the vertebra. Thespinous process extends from the rear portion of the vertebra and thetransverse processes extend from each side of each vertebra. Both thespinous process and the transverse process connect muscle tissue andligaments to the spine. The vertebral canal is formed between thevertebral body and the lamina and houses the spinal cord therein. Thepedicle is connected to the vertebral body and supports the lamina.

The spinal column may be subject to numerous abnormalities and disorderswhich can be caused by trauma, disease, or genetic defect such asruptured or slipped discs, degenerative disc disease, fracturedvertebrae as so forth. Such defects can result in conditions causingextreme pain a reduced or abnormal nerve function. These spinalabnormalities can potentially cause damage the nervous system and inparticular the spinal cord and likewise impair the normal freedom ofmotion of the spinal column.

It is not uncommon to treat such abnormalities surgically by spinalfusion wherein one or more vertebral bodies are fused together. However,spinal fusion may limit the spinal cord's range of motion in rotationand lateral bending. In addition, spinal fusion may increase the stressplaced upon non fused adjacent vertebral bodies thereby diminishingtheir structural integrity. Moreover, the fusion device or material maybecome dislodged move away from the area of implantation.

A wide variety of approaches have been in use to achieve spinal fusionby implanting artificial devices in or on the spinal column to result inimmobilization. One approach utilizes an anterior implant where theimplant is located on the anterior, or front portion, of the vertebralbody. An anterior stabilization can include full or partial discreplacement by a rigid spacer that is approximately the size of the discthat has been removed. A different approach involves the utilization ofa posterior implant. Posterior implants include rods that are attachedto either the lamina or transverse process by hooks or by pediclescrews. Other posterior implants allow for flexible or dynamicstabilization using pedicle screws connected by rigid or flexible rodmember. Prior art posterior pedicle screw based stabilization systemscreate forces that are often transferred to the anchored pedicle screws.Patients having a relatively brittle bone structure cannot withstand themagnitude of these forces without resulting in the failure of theanchoring system.

DESCRIPTION OF THE PRIOR ART

One example of a dynamic anchoring device is disclosed in US PatentApplication Publication 2004/0025289 by Biedermann et al. The deviceincludes an element for anchoring in a bone or vertebra and a headconnected to the shank, a receiving part for receiving the head, and apressure element acting on the head, wherein the pressure element isresilient so that upon a movement of the element from a first angularposition of the shank relative to said receiving part into a secondangular position the pressure element exerts a return force onto thehead to urge the element towards the first angular position.

Another example of a dynamic anchoring device is disclosed in US PatentApplication Publication 2005/014823 to Boyd et al. The dynamicstabilization system disclosed therein includes bone anchors having aflexible portion between the bone engaging and head portions of theanchor.

U.S. Patent Application Publication 2005/0216003 to Biedermann et aldiscloses a bone anchoring element such as a screw. The screw has ashaft and a first head. A second head is elastically connected to thefirst head. The second head is arranged in the receiving member suchthat the second head can pivot or swivel. The second head is fixed inthe resting member in an angular resting position. The screw isdeflectable from the angular head position relative to the second head.The second head is elastically connected to the first head such that arestoring force returns the screw to the angular resting position. Theresting angular position of the shaft relative to the receiving part isadjustable.

U.S. Patent Application Publication 2006/0129147 to Biedermann et aldiscloses a stabilization device for bones or vertebrae that comprises asubstantially cylindrical elastic element. The elastic element has afirst end and a second end opposite to the first end. An elastic sectionextends between the first end and the second end. The elastic sectionincludes at least first and second helical coils. The first and secondhelical coils are arranged coaxially so that the first helical coilextends at least in a portion between the second helical coil. Theelastic element may form, for example, a portion of a rod, boneanchoring element, or plate.

U.S. Patent Application Publication 2007/0055236 to Hudgins et aldiscloses an apparatus and method for stabilizing the facet joints ofthe spine. The facet implant may be in the form of a screw or otheranchor with the intermediate portion in the form of a polyaxial head, acord a spring, etc.

Another device for the dynamic fixation of impaired spinal columnsegments in disclosed in U.S. Published Patent Application 2007/0233087to Schlapfer. The device includes an intermediate element for adetachable, lockable, ball joint like connection having an outer wallconcentric with the longitudinal axis and an inner wall forming acoaxial cavity. Either the outer wall or the inner wall comprises one oftwo contact zones that form the ball joint like connection. Theintermediate element is at least partly made of a super elasticmaterial.

U.S. Published Patent Application 2008/0021465 to Shadduck et aldiscloses a spine implant device for fusion or dynamic stabilization ofa spine segment that includes a fixation device with a shaft portion forengaging bone and a proximal end for coupling to a rod that allows forlimited flexing of the proximal end relative to the shaft portion.

A further example of a dynamic spinal stabilization system is disclosedin US Published Patent Application 2008/0071273 to Hawkes et al.Disclosed is a system for stabilizing at least one spinal motion segmentthat includes a fastener having an anchoring portion and a couplingportion and a longitudinal support member couple to the fastener whereina portion of the system is formed from a super-elastic material.

SUMMARY OF THE INVENTION

The present invention relates to a spinal stabilization system thatprovides for dynamic stabilization using a modular screw in conjunctionwith a rigid or non-rigid rod that permits load transfer at the pediclescrew rod interface as opposed to the dynamic rod per se. The screw hasan elastic segment interposed between a threaded portion of the screwand the screw head portion, also referred to as a “tulip”. The amount ordegree of motion can be varied based on the rigidity or flexibility ofthe elastic material as well as the length and diameter of the elasticmaterial. The pedicle screw is designed to be used in a percutaneousdynamic spinal stabilization system. The screw can be used in a singleor multi level construct in combination with a titanium, PEEK or Nitinolrod. The dynamic screw design enables percutaneous delivery of thestabilization system although the dynamic system can be used in an openapplication as well.

The dynamic spinal stabilization system includes a dynamic modularpedicle screw system which in turn preserves motion in the posteriorcolumn of the human spine. The dynamic screws can be used in conjunctionwith a rigid or non-rigid rod. The dynamic pedicle screw used with arigid rod will allow for the load transfer to occur at the screw/rodinterface as opposed to a non-physiologic load transferred through adynamic rod alone. Alternatively, the modular pedicle screw can includea rigid segment interposed between a threaded portion of the screw andthe screw head portion, also referred to as a “tulip”.

Accordingly, it is a primary objective of the instant invention toprovide a semi dynamic spinal stabilization system that allows forvariable customization of the elastic member thereby increasing theability to specifically address a greater number of pathologies.

It is a further objective of the instant invention to provide absorptionof the dynamic force transmission within the anchoring screw and not atthe bone-screw interface.

It is yet another objective of the instant invention to provide amodular pedicle screw that is designed to be used in a percutaneousdynamic stabilization system.

It is a still further objective of the invention is to provide a kit ofmodular anchoring devices for a dynamic spinal stabilization system. Theanchoring device is a three part design including a threaded rigidshank, an intermediate component that is an elastic polymer or rigidmaterial, and a rigid multi-axial tulip. The kit would include aplurality of threaded shanks of varying sizes, a plurality ofintermediate portions of varying geometries and rigidities, and aplurality of tulip heads.

It is a further object of the invention to provide an intermediatecomponent that is designed to be removable from the threaded shankportion subsequent to implantation of the pedicle screw should thepathology change thereby necessitating a change in the flexibility ofthe dynamic system. The ability to change the dynamism of thestabilization system without removing the threaded shank portion allowsthe surgeon to maintain the original bone purchase in the patient whichfacilitates the procedure, the healing process and improves thepotential for long term success.

Another distinct objective of the system is to provide a morecomprehensive yet less invasive method to address more complex spinecases, i.e. spinal deformity cases. Currently, dynamic systems arelimited in their applicability and mostly ruled out for use in morecomplex spine cases. One reason may be due to the limited ability tomanipulate the individual spine segments in order to obtain the overallcorrection/objective. This reinforces a current perception that a moreinvasive technique is always required. This system may not be applicablein all complex cases however it will be a minimallyinvasive/percutaneous dynamic screw option for surgeons to consider

Other objects and advantages of this invention will become apparent fromthe following description taken in conjunction with any accompanyingdrawings wherein are set forth, by way of illustration and example,certain embodiments of this invention. Any drawings contained hereinconstitute a part of this specification and include exemplaryembodiments of the present invention and illustrate various objects andfeatures thereof.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 is a perspective disassembled view of the dynamic modular pediclescrew.

FIG. 2 is a perspective view of the dynamic spine stabilization systemshowing a multi level construction utilizing a pair of dynamic pediclescrews and a stabilization rod.

FIG. 3A is a top view of the elastic intermediate member.

FIG. 3B is a side view of the elastic intermediate member.

FIG. 3C is a sectional perspective view of the elastic intermediate.

FIG. 4A is a top view of a second embodiment for the elasticintermediate member.

FIG. 4B is a side view of the second embodiment for the elasticintermediate member.

FIG. 4C is a sectional perspective view of the second embodiment for theelastic intermediate member.

FIGS. 5A and 5B show various configurations for the elastic portion andtheir relative dynamic properties.

FIG. 6A is an exploded side view of the lower coupling the intermediatemember and the threaded shank.

FIG. 6B is a top view of the lower coupling member of the intermediatemember.

FIG. 6C is a top of view of the threaded shank portion.

FIG. 7A is a side view of the upper coupling member and the tulip head.

FIG. 7B is a top view of the tulip head component.

FIG. 7C is a top view of the upper coupling member of the intermediateelement.

DETAILED DESCRIPTION OF THE INVENTION

FIG. 1 shows a dissembled view of the modular dynamic pedicle screw 1.Screw 1 includes a threaded shank portion 2 having a one end that tapersinto a point 4 at one end and has an opposite end 6 that includes acoupling element 8. Coupling element 8 includes internal female threads10. The pedicle screw 1 has a channel 20 through the entire length ofthe pedicle screw, including the tulip head 12, the intermediatecomponent 14, and the threaded shank portion 2. This channel 20 allowsthe pedicle screw 1 to be maneuvered on a Kirschner wire 22, also knowas a K-wire. In practice the K-wire is positioned within the patientusing fluoroscopy, or other imaging techniques, so as to provide precisepositioning of the pedicle screw 1. Once the components are securelypositioned the K-wire can be easily removed through the channel 20 whichis open at the end of the threaded shank portion and extends through theuppermost portion of the head portion or tulip 12. The threaded shank 2is externally threaded. The threads 3 can be fenestrated or partiallyfenestrated. Fenestrated threads are particularly appropriate forosteoporotic patients or patients who require greater assurance ofincreased pedicle screw purchase based on bone quality. The threadedshank 2 of the pedicle 1 are appropriately sized in relation to thepatient's pathology and can be formed in different lengths and externalthreaded diameters.

The head or tulip portion 12 of the pedicle screw 1 includes upwardlyextending cylindrical wall 15 wherein grooves 17 are positioned indiametrically opposed relationship. These opposing grooves 18 allow fortop loading of either a rigid or non rigid rod 30 into the tulip. Thetulip may be fixed or multi axial. The inner portion of the cylindricalwall accepts a threaded lock screw 32 to secure the rod 30 to thepedicle screw 1. The tulip design can accept tulip extension towers,attached to tulip portion 12, which will facilitate the percutaneouspassing of the rod 30 through multiple screws based upon the number ofspinal segments involved in the overall dynamic spinal stabilizationsystem. The tulip extensions allow for external control of the tuliphead during the rod delivery process. The screw extensions that areattached to the tulip portions remain in place until the percutaneousdelivery and placement of the rod 30 has been achieved and threaded lockscrews 32 have been finally tightened. In addition, the pedicle screw 1is also configured to receive a shank extension tower. The screwextension tower is a completely rigid device that extends dorsallythrough the skin incision. This feature enables three dimensionalmanipulation of the spine segment. Once the rigid manipulation of thesegment is complete the screw extension tower is removed and the dynamicmember is fully functional. The tulip design allows for top loading ofthe rod 30 delivered under direct visualization as is possible when thesurgery is performed under open conditions. A coupling element 21 havinga cylindrical wall with external threads for engagement with theintermediate member 14 is attached to tulip portion 12 with a ball andsocket arrangement 24.

The intermediate portion 14 of the dynamic pedicle screw includes anelastic portion 40, an upper coupling member 16 and a lower couplingmember 18. As shown in FIGS. 3A-3C, portion 40 is generally cylindricalin shape and includes a passageway 42 concentric with the longitudinalaxis of the cylindrical body. The portion 40 is formed from elasticmotion preserving dynamic material which allows for the requisite degreeof motion and is capable of standing the mechanical loads associatedwith the human spine. This provides intraoperative flexibility for thesurgeon to choose or customize the construct to address the patient'sspecific pathology. The portion 40 is available in varying levels,ranges and modes of dynamism, such as dynamic, motion preserving,non-fusion and rigid. Dynamism can be adjusted based on the type ofmaterial used, for example Nitinol or polycarbonate, the length of thecylinder, the diameter and or wall thickness of the cylinder or anycombination of the above variables (as shown in FIGS. 5A and 5B).Embedded within the wall of cylindrical portion 40 is a jacket 44 madefrom a polyester material, or the like, which extends outwardly fromeach end of the cylinder 40, as shown in FIGS. 3A through 3C. A secondembodiment, shown in FIGS. 4A through 4C utilizes a polyester, or thelike, jacket that surrounds the outer surfaces of cylindrical member 40and extends outwardly from each end of the cylinder 40. Extendingportions 48 of the jacket extend into tabs formed in the upper and lowercoupling members, 16 and 18 respectively, to complete the assembly ofthe intermediate portion 14. Upper coupling member 16 includes acylindrical wall having an externally threaded surface. Upper couplingmember 16 is threadably connected to tulip coupling member 22. Likewise,lower coupling member 18 includes a cylindrical wall having anexternally threaded surface. Lower coupling member 18 is screwed on tocoupling member 8 positioned on the threaded shank portion 2. As analternative, cylindrical member 40 can be bonded, glued or moldeddirectly on to the upper and lower coupling members, 16 and 18respectively, without the utilization of a jacket.

The intermediate portion can also be rigid allowing for rigid fixation.In order to assemble a rigid modular screw a non-elastic intermediateportion 14 is coupled to the threaded shank portion 2 and the tulip headportion 12. In this instance, cylindrical member 40 can be made from thesame material as the threaded shank 2 or the tulip head 12 or some otherrigid compatible material. The non-elastic cylindrical member 40 can bethreaded into upper and lower coupling members or otherwise suitablyaffixed thereto.

FIG. 6A illustrates the lower coupling member 18 and the threaded shank2 with its coupling member 8. Annular threads 10 on coupling 8 mate withexternal threads on lower coupling member 18. FIG. 6B is a top view oflower coupling member 18 showing a socket 19 that includes a portion ofchannel 20. Socket 19 is designed to operatively engage an insertion orremoval tool which can be inserted through the intermediate portion 14via channel 20. Should it be necessary to change the dynamiccharacteristics of the spinal support system the surgeon would removethe rod 30 from the head 12 by first removing threaded lock screw 32.Following removal of the rod 30 the head portion 12 would be unthreadedfrom the intermediate portion 14 using an appropriate tool. Thereafter,a tool would be inserted through the channel 20 in the intermediatemember 14 to engage socket 19 formed in lower coupling member 18. Uponrotation of the tool the lower coupling 18 of the intermediate memberwill be unthreaded from the second coupling 8 formed on the threadedshank portion 2. The intermediate portion can then be removed from thepatient. A new intermediate portion 14 can then be positioned over theexisting threaded shank portion 2. Thereafter a tool would be insertedthrough channel 20 of the intermediate member 14 and engage socket 19formed in the lower coupling member 8. Upon rotation of the tool thelower coupling 18 of the intermediate member 14 will be threaded intothe second coupling formed on the treaded shank 2. The head portion 12can then be threaded onto the intermediate portion 14 and the rod 30 canbe affixed thereto by locking screw 32. The ability to change thedynamism of the stabilization system without removing the threaded shankportion allows the surgeon to maintain the original bone purchase in thepatient which facilitates the procedure, the healing process andimproves the potential for long term success. FIG. 6C is a top view ofthe threaded shank 2 with channel 20 and coupling threads 10.

FIG. 7A is a side view showing tulip head member 12 with cylindricalside walls 15 and groove 17. A coupling element 21 having a cylindricalwall with external threads for engagement with the intermediate member14 is attached to tulip portion 12 with a ball and socket arrangement24. FIG. 7B is a side view of tulip head member 12. FIG. 7C is a topview of the upper coupling member 16.

The rod 30 connects multiple screws based upon the number of segmentsinvolved in the overall construct. The rod can be of any compatiblematerial (PEEK, Titanium, Nitinol, etc). This also increases theversatility of the system allowing for more control in defining therigidity or dynamism of the overall construct. The rod 30 used inconjunction with the dynamic pedicle screw system can be either rigid ornon rigid.

All patents and publications mentioned in this specification areindicative of the levels of those skilled in the art to which theinvention pertains. All patents and publications are herein incorporatedby reference to the same extent as if each individual publication wasspecifically and individually indicated to be incorporated by reference.

It is to be understood that while a certain form of the invention isillustrated, it is not to be limited to the specific form or arrangementherein described and shown. It will be apparent to those skilled in theart that various changes may be made without departing from the scope ofthe invention and the invention is not to be considered limited to whatis shown and described in the specification and any drawings/figuresincluded herein.

One skilled in the art will readily appreciate that the presentinvention is well adapted to carry out the objectives and obtain theends and advantages mentioned, as well as those inherent therein. Theembodiments, methods, procedures and techniques described herein arepresently representative of the preferred embodiments, are intended tobe exemplary and are not intended as limitations on the scope. Changestherein and other uses will occur to those skilled in the art which areencompassed within the spirit of the invention and are defined by thescope of the appended claims. Although the invention has been describedin connection with specific preferred embodiments, it should beunderstood that the invention as claimed should not be unduly limited tosuch specific embodiments. Indeed, various modifications of thedescribed modes for carrying out the invention which are obvious tothose skilled in the art are intended to be within the scope of thefollowing claims.

1. A modular dynamic pedicle screw system comprising: a plurality of modular dynamic pedicle screws and a rod, each modular pedicle screw including a head portion, an intermediate portion, and a threaded shank portion, said head portion including a cylindrical wall with diametrically opposed grooves that extend downwards from the top of said cylindrical wall, said grooves are sized and configured to receive said rod within said diametrically opposed grooves, and a lock screw configured to engage threads formed on an inner surface of said cylindrical wall thereby securing said rod to said head portion, said head portion including a first channel formed coincident with its longitudinal axis and open at the top and the bottom of the head portion, and, a first coupling element connected to said head portion, said intermediate portion including an elastic portion and an upper coupling member and a lower coupling member, said elastic portion and said upper and lower coupling being fixedly connected, said intermediate portion including a second channel extending coincident with its longitudinal axis and open at the top and bottom of said intermediate member, said threaded shank portion including a threaded and tapered outer surface and a second coupling member formed at one end thereof, said threaded shank portion and said second coupling member each having a third channel formed coincident with the longitudinal axis of said threaded shank portion and open at the top and bottom of said threaded shank portion, said first, second and third channels are configured to be in alignment with one another, whereby a wire can pass freely from the open bottom end of the threaded shank portion, through the intermediate portion, and out the open top end of the head portion and be completely removed from the pedicle screw.
 2. The modular dynamic pedicle screw system of claim 1, wherein the first coupling of the head portion is threadably engaged by the upper coupling of the intermediate portion.
 3. The modular dynamic pedicle screw system of claim 1, wherein the second coupling of the threaded shank portion is threadably engaged by the lower coupling of the intermediate portion.
 4. The modular dynamic pedicle screw system of claim 1, wherein said elastic portion is generally cylindrical in shape.
 5. The modular dynamic pedicle screw system of claim 4, wherein in the elastic portion further includes a jacket that surrounds the outer surfaces of said cylindrical elastic portion and extends outwardly from the top and bottom ends of the cylinder, the jacket portion extending outward from the top of the cylinder is affixed into tabs located in the upper coupling member and the jacket portion extending outward from the bottom of the cylinder is affixed into tabs formed in the lower coupling member, thereby completing the assembling of the intermediate portion.
 6. The modular dynamic pedicle screw system of claim 4, wherein in the elastic portion further includes a jacket in imbedded between the outer surfaces of said cylindrical elastic portion and extends outwardly from the top and bottom ends of the cylinder, the jacket portion extending outward from the top of the cylinder is affixed into tabs located in the upper coupling member and the jacket portion extending outward from the bottom of the cylinder is affixed into tabs formed in the lower coupling member, thereby completing the assembling of the intermediate portion.
 7. The modular dynamic pedicle screw system of claim 1 wherein said head portion includes a ball and socket connection between the cylindrical wall portion and the first coupling element.
 8. The modular dynamic pedicle screw system of claim 1 wherein said rod is flexible.
 9. The modular dynamic pedicle screw system of claim 1 wherein said rod is rigid.
 10. The modular dynamic pedicle screw system of claim 1 wherein said lower coupling includes at least one surface that can be engaged by a tool passing through the second channel whereby the intermediate portion can be rotated in either direction causing the lower coupling to be either threaded or unthreaded from the second coupling on the threaded shank.
 11. A modular dynamic pedicle screw comprising: said modular dynamic pedicle screw including a head portion, an intermediate portion, and a threaded shank portion, said head portion including a cylindrical wall with diametrically opposed grooves that extend downwards from the top of said cylindrical wall, said grooves are sized and adapted to receive a rod within said diametrically opposed grooves, and a lock screw configured to engage threads formed on an inner surface of said cylindrical wall thereby securing said rod to said head portion, said head portion including a first channel formed coincident with its longitudinal axis and open at the top and the bottom of the head portion, and, a first coupling element connected to said head portion, said intermediate portion including an elastic portion and an upper coupling member and a lower coupling member, said elastic portion and said upper and lower coupling being fixedly connected, said intermediate portion including a second channel extending coincident with its longitudinal axis and open at the top and bottom of said intermediate member, said threaded shank portion including a threaded and tapered outer surface and a second coupling member formed at one end thereof, said threaded shank portion and said second coupling member each having a third channel formed coincident with the longitudinal axis of said threaded shank portion and open at the top and bottom of said threaded shank portion, said first, second and third channels are configured to be in alignment with one another, whereby a wire can pass freely from the open bottom end of the threaded shank portion, through the intermediate portion, and out the open top end of the head portion and be completely removed from the modular dynamic pedicle screw.
 12. The modular dynamic pedicle screw of claim 11, wherein the first coupling of the head portion is threadably engaged by the upper coupling of the intermediate portion.
 13. The modular dynamic pedicle screw of claim 11, wherein the second coupling of the threaded shank portion is threadably engaged to the lower coupling of the intermediate portion.
 14. The modular dynamic pedicle screw of claim 11, wherein said elastic portion is generally cylindrical in shape.
 15. The modular dynamic pedicle screw of claim 14, wherein in the elastic portion further includes a jacket that surrounds the outer surfaces of said cylindrical elastic portion and extends outwardly from the top and bottom ends of the cylinder, the jacket portion extending outward from the top of the cylinder is affixed into tabs located in the upper coupling member and the jacket portion extending outward from the bottom of the cylinder is affixed into tabs formed in the lower coupling member, thereby completing the assembling of the intermediate portion.
 16. The modular dynamic pedicle screw of claim 14, wherein in the elastic portion further includes a jacket in imbedded between the outer surfaces of said cylindrical elastic portion and extends outwardly from the top and bottom ends of the cylinder, the jacket portion extending outward from the top of the cylinder is affixed into tabs located in the upper coupling member and the jacket portion extending outward from the bottom of the cylinder is affixed into tabs formed in the lower coupling member, thereby completing the assembling of the intermediate portion.
 17. The modular dynamic screw of claim 11, wherein said head portion includes a ball and socket connection between the cylindrical wall portion and the first coupling element.
 18. The modular dynamic screw of claim 11, wherein said lower coupling includes a socket that can be engaged by a tool passing through the second channel whereby the intermediate portion can be rotated in either direction causing the lower coupling to be either threaded or unthreaded from the second coupling on the threaded shank.
 19. A kit for a modular screw stabilization system comprising; components to assemble a plurality of modular pedicle screws and one or more rods, each modular pedicle screw including a head portion, an intermediate portion, and a threaded shank portion, said kit including a plurality of said head portions each including a cylindrical wall with diametrically opposed grooves that extend downwards from the top of said cylindrical wall, said grooves are sized and configured to receive said rod within said diametrically opposed grooves, and a lock screw configured to engage threads formed on an inner surface of said cylindrical wall thereby securing said rod to said head portion, said head portions including a first channel formed coincident with its longitudinal axis and open at the top and the bottom of the head portion, and, a first coupling element connected to each of said head portion, said kit further including a plurality of intermediate portions each including an elastic portion or a rigid portion and an upper coupling member and a lower coupling member, said elastic or rigid portion and said upper and lower coupling being fixedly connected, each of said plurality of intermediate portions including a second channel extending coincident with its longitudinal axis and open at the top and bottom of said intermediate member, said kit also including a plurality of said threaded shank portions, each including a threaded and tapered outer surface and a second coupling member formed at one end thereof, each said threaded shank portions and each of said second coupling members each having a third channel formed coincident with the longitudinal axis of each of said threaded shank portions and open at the top and bottom of each of said threaded shank portions, said first, second and third channels are configured to be in alignment with one another, whereby a wire can pass freely from the open bottom end of the threaded shank portion, through the intermediate portion, and out the open top end of the head portion and be completely removed from the pedicle screw.
 20. The kit for a dynamic screw stabilization system as set forth in claim 19 wherein; said plurality of threaded shank portions are of the same or different lengths and external diameters.
 21. The kit for a dynamic screw stabilization system as set forth in claim 19 wherein at least some of the threaded shank portions have fenestrated and partially fenestrated threads.
 22. The kit for a dynamic screw stabilization system as set forth in claim 19 wherein the plurality of intermediate portions have elastic portions of same or varying rigidity.
 23. The kit for a dynamic screw stabilization system as set for in claim 22 wherein the elastic portion varies in rigidity from rigid to flexible.
 24. A modular dynamic pedicle screw system comprising: a plurality of pedicle screws and a rod, each modular pedicle screw including a head portion, an intermediate portion, and a threaded shank portion, said head portion including a cylindrical wall with diametrically opposed grooves that extend downwards from the top of said cylindrical wall, said grooves are sized and configured to receive said rod within said diametrically opposed grooves, and a lock screw configured to engage threads formed on an inner surface of said cylindrical wall thereby securing said rod to said head portion, said head portion including a first channel formed coincident with its longitudinal axis and open at the top and the bottom of the head portion, and, a first coupling element connected to said head portion, said intermediate portion including a rigid portion and an upper coupling member and a lower coupling member, said rigid portion and said upper and lower coupling being fixedly connected, said intermediate portion including a second channel extending coincident with its longitudinal axis and open at the top and bottom of said intermediate member, said threaded shank portion including a threaded and tapered outer surface and a second coupling member formed at one end thereof, said threaded shank portion and said second coupling member each having a third channel formed coincident with the longitudinal axis of said threaded shank portion and open at the top and bottom of said threaded shank portion, said first, second and third channels are configured to be in alignment with one another, whereby a wire can pass freely from the open bottom end of the threaded shank portion, through the intermediate portion, and out the open top end of the head portion and be completely removed from the modular pedicle screw. 